The implementation of guidelines in a South African population with type 2 diabetes
Objective: The aim of this study was to identify the treatment gaps that pertain to risk factors in South African patients with type 2 diabetes mellitus, using national treatment guidelines.
Design: Cross-sectional study.
Setting and subjects: The study consisted of 666 patients with type 2 diabetes mellitus, attending a diabetes clinic at the Charlotte Maxeke Johannesburg Academic Hospital.
Outcome measures: Using a public sector database, retrospective data were obtained on the treatment of type 2 diabetes mellitus participants. Patients were randomly selected on the basis of established type 2 diabetes mellitus diagnosis, and if they were receiving oral hypoglycaemic and/or insulin therapy. Age, gender, race, blood pressure, haemoglobin A1c (HbA1c) and fasting lipids were captured and measured. The history of patients’ previous coronary artery disease, strokes, nephropathy, neuropathy and retinopathy was recorded.
Results: The mean age of the patients was 63 years [standard deviation (SD) 11.9], 55% of whom were females. The HbA1c was 8.8% (SD 2.5). 26.2% of patients attained HbA1c levels of < 7%. Of the total patients, 45.8% met a < 130/80 mmHg blood pressure target, and 53.8% a low-density lipoprotein (LDL) cholesterol of < 2.5 mmol/l. Only 7.5% obtained the combined target for HbA1c , blood pressure and LDL cholesterol.
Conclusion: Traditionally, type 2 diabetes mellitus treatment has centred on correcting blood glucose levels. Yet, as many as 80% of people with type 2 diabetes mellitus die from some form of cardiovascular disease (CVD). Many trials have demonstrated the benefits of targeting CVD risk factors (HbA1c, blood pressure and lipids) in patients with type 2 diabetes mellitus. Despite the wealth of evidence, our data suggest that significant undertreatment of risk factors in patients with type 2 diabetes mellitus remains.
Keywords: diabetes mellitus, risk factors, targets, management
Material submitted for publication in the Journal of Endocrinology, Metabolism and Diabetes of South Africa (JEMDSA) is accepted provided it has not been published elsewhere. JEMDSA reserves copyright of the material published. Neither JEMDSA nor the Publisher may be held responsible for statements made by the authors.